Tag Archives: Transportation

Today at 1:30PM- 3:30PM PST the third and final public listening session will be held at the Westin Bonaventure Hotel and Suites, 404 S. Figueroa St. in Los Angeles. On March 10, 2016 The Federal Motor Carrier Safety Administration and Federal Railroad Administration announced a notice of proposed rule making to receive feedback about any potential sleep apnea regulations. Information on the prevalence of moderate-to-severe obstructive sleep apnea (OSA) among individuals occupying safety sensitive positions in highway and rail transportation, and of its potential consequences for the safety of rail and highway transportation can be solicited at this hearing as well as be submitted online in the form of comments. The 90-day comment period will be ending June 8, 2016.

Through the listening session, interested parties will have one last opportunity to share their views and any data or analysis regarding sleep apnea with representatives of the FMCSA and FRA. As a contributor, you are asked to identify whether you are in the transportation industry or medical profession, but you can choose to remain anonymous. The Agencies will transcribe all comments and place the transcripts in the dockets FMCSA-2015-0419 and FRA-2015-0111.

Previous listening sessions took place May 12 in Washington, D.C., and May 17 in Chicago. Highly prioritized concerns during the sessions have included the cost of sleep studies for drivers and locomotive engineers, the failure of most safety-sensitive transportation employees with apnea to use their CPAP machines and ensuring that any apnea mandates consider safety benefits over costs and driver health.

As ASBA members, we need to provide input on how it is important to driver and public safety to be treated for OSA. For those who are unable to attend in person, the entire proceedings of today’s listening session will be available on the through a live webcast, which can be found here.

Publisher of Sleep Diagnosis and Therapy Journal the Official publication of the American Sleep and Breathing Academy, the Journal is a clinical and technical publication for dental and medical professionals.

Reprinted with update from an article in Health and Wellness Magazine Nov, 2013

Every year in America there are nearly 500,000 commercial truck accidents, and, according to the Federal Motor Carrier’s Safety Administration, driver fatigue accounts for nearly 40% of these accidents. Obstructive sleep apnea is an incredibly frequent and treatable cause of the truckers’ fatigue, yet most truck drivers have not been tested for sleep apnea and, due to the inconvenience of common sleep apnea treatments, even fewer are being treated for their fatigue. For years this problem has remain unaddressed. However as Executive Director of the Dental Division of the American Sleep and Breathing Academy, I think our team can make our highways safer.

Also as founder and President of Pro Player Health Alliance, an organization which teams up with retired professional sports players to promote sleep apnea awareness, I have had the opportunity to help numerous former NFL players achieve a better night’s sleep. I noticed that, like NFL players, truckers endure long periods of travel and are frequently overweight, which places them at a higher risk of having obstructive sleep apnea. In fact, according to a recent study by the Federal Motor Carrier Safety Administration, a third of American truck drivers have medium to severe sleep apnea.

Thus, On July 11th 2013 I, as well as Dr. Elliott Alpher and Dr. Richard Klein, met with the Department of Transportation to present ways to treat truck drivers for obstructive sleep apnea. The conventional treatment method for obstructive sleep apnea involves using a Controlled Positive Airway Pressure (CPAP) device. However these machines are bulky and require electricity, usually from large batteries, in order to function. Therefore most truck drivers, due to their frequent traveling, find CPAP devices to be very inconvenient. Furthermore, according to the American Thoracic Society, even in the general patient population, between 46% and 83% of CPAP patients will not adhere to CPAP therapy. Instead, we recommended for truck drivers the same treatment already been using for NFL players: oral appliance therapy.

Since 1981, Gergen’s Orthodontic Lab has been designing the highest quality oral appliances. Based on my experience, I feel that an oral appliance is

David Gergen and Josh Fowler celebrate another milestone

safe, affordable, easily transported, and non-electric, which makes it ideal for a trucker’s lifestyle. In the past, CPAP has been favored because of its ability to measure compliance and usage. However, with the addition of a new panel of sensors invented by Dr. Bonato, CEO of Braebon, who was also at the meeting, any of the oral appliances made with the sensor by Gergen’s can be used to measure compliance and usage. Appliances include the Sleep Herbst, EMA, Respire, TAPs and the newest addition invented by Steven Harkins, the Twilite Appliance which has successfully treated over 300 patients.

Furthermore even the sleep apnea screening process can be made simpler and more portable by using new technology which could record data from off-site locations such as a hotel room or even the cab of a truck. With the availability of this new portable technology, I believe that truckers deserve the same treatment that we have been delivering to NFL players for years.

The Department of Transportation agreed with our presentation and the government responded. On October 15th 2013 a major step was taken toward making America’s highways safer when President Obama signed into law H.R. 3095, which requires screening all commercial truck drivers for sleep apnea. Screening for sleep apnea will make thousands of drivers aware of the cause for their drowsiness and will encourage them to pursue treatment.

Still, there are more workers in the transportation sector who could be helped by sleep apnea screening and oral appliance treatment, including train operators and pilots. For example, a most recent event in Brooklyn unfortunately involved a train engineer falling asleep at a turn, derailing and flipping the train. Sleep apnea was later to be believed as the cause of this accident, although sleep test results have not been confirmed to date. However, Dr. Klein best captures the importance of October’s decision by saying, “Last year over 200,000 people on the roadways in this nation lost their lives due to sleepy drivers and now American roads will be safer and drivers can feel more confident in their safety.”

David Gergen

Since he received the award for The Finest Orthodontic Technician in the country given by Columbus Dental in 1986, he has worked for some of the pioneers in the orthodontic and sleep dentistry fields. He was the personal technician for the likes of Dr. Harold Gelb, Dr. Robert Ricketts, Dr. Ronald Roth, Dr. A. Paul Serrano, Dr. Clark Jones, Dr. Arthur Gaus, Dr. Joseph R. Cohen and Dr. Edward Spiegel. He has also taught orthodontic technicians at Arizona Institute of Technology for dental and medical careers. David has also been active on the Arizona State University Sports and Medicine team since 1991. He also received in 2012 a lifetime achievement award by the Gelb Academy as America’s greatest Orthodontic technician of all time. David can be reached at www.Gergensortho.com

David Gergen, CDT and President of Pro Player Health Alliance, has been a nationally respected dental lab technician for over 25 years. He received the award for “The Finest Orthodontic Technician in the Country” given by Columbus Dental in 1986. He also has been appointed Executive Director of the American Sleep and Breathing Academy Dental Division, a national interdisciplinary academy dedicated to sleep training and education with over 60,000 members. David rolled out of bed on December 4, 1982 and had his career “ah ha” moment. He knew he was going to be an orthodontic technician and he knew he was going to help people all over the country to help treat their sleep disorders in partnership with their dentists. He has worked for some of the pioneers in the orthodontic and sleep dentistry fields. He was the personal technician for the likes of Dr. Robert Ricketts, Dr. Ronald Roth, Dr. A. Paul Serrano, Dr. Clark Jones, Dr. Harold Gelb, Dr. Joseph R. Cohen, Dr. Rodney Willey, Dr. Allan Bernstein, and Dr. Thien Pham. One of his proudest achievements is receiving The National Leadership award for Arizona Small Businessman of the Year in 2004.

The trucking industry does not want the Federal Motor Carrier Safety Administration (FMCSA) to use “informal guidance” to address sleep apnea. The House Transportation and Infrastructure Committee agreed, quickly approving a bill that would instead require “rulemaking.”

“ATA [American Trucking Association] believes that testing alone for obstructive sleep apnea of truck drivers could cost the industry nearly $1 billion,” said ATA president and CEO Bill Graves. “If our industry is to be burdened with such a cost, then the FMCSA owes it to trucking to conduct a full and thorough rulemaking, including collection of scientific data and a cost-benefit analysis.”

The bill, introduced by Reps Larry Bucshon (R-Ind) and Dan Lipinski (D – Ill) reportedly has broad bipartisan support, already garnering nearly 50 cosponsors. “While FMCSA has said they are receptive to a rulemaking process in lieu of sleep apnea guidance, we urge the House and Senate to follow through with swift approval of HR 3095,” said Graves.

“FMCSA will issue a notice to address obstructive sleep apnea through the formal rulemaking process after collecting and analyzing the necessary data and research,” the agency said in a statement. The statement does not address the broader issue of sleep disorders.

According to a report in TruckingInfo.com, the FMCSA proposed tougher standards for sleep apnea evaluation last year. The proposed guidance in 2012 mandated that drivers with a body mass index of 35 or more must be evaluated for sleep apnea. The advisory committees supported the “guidance” approach but saw it as an interim step toward a comprehensive rule.

“Trucking interests have registered deep concern about the use of a guidance, and have been pushing for the rulemaking approach,” writes Oliver Patton in TruckingInfo. “They worry that the guidance will not give employers a clear enough statement of their legal responsibilities.”

Don Osterberg, senior vice president of Safety, Security and Driver Training for Schneider National, reportedly told Deputy Transportation Secretary John Porcari that a guidance has the effect of putting trucking companies in a tight legal spot. “It puts motor carriers in a situation where we can pick our lawsuit,” he said.

The ATA, America’s largest trucking industry association, is on record in support of the new Bucschon/Lipinski Bill.

Czeisler said studies show that 30 percent to 50 percent of night-shift workers report falling asleep at least once a week while on the job.

So the notion that this has happened only a few times among the thousands of controllers “is preposterous,” he said in a telephone interview.

In a sign of growing awareness of the problem, the Federal Aviation Administration said Saturday it was changing air traffic controllers’ work schedules most likely to cause fatigue. The announcement comes after the agency disclosed another incident in which a controller fell asleep while on duty early Saturday morning at a busy Miami regional facility. According to a preliminary review, there was no impact to flight operations, the FAA said.

Czeisler said the potential danger isn’t limited to air traffic controllers, but can apply to truck and bus drivers, airline pilots and those in the maritime industry. Who else? Factory workers, police, firefighters, emergency workers, nurses and doctors, cooks, hotel employees, people in the media and others on night or changing shifts.

“We live in a very sleep-deprived society where many people are burning the candle at both ends,” Czeisler said. He said that a half-century ago, just 2 percent of people slept six hours or less per night; today it’s 28 percent.

Dr. William Fishbein, a neuroscientist at the City University of New York, said that when people work odd shifts “it mucks up their biological rhythms.”

Hormones are synchronized with the wake-sleep cycle. When people change shifts, the brain never knows when it’s supposed to be asleep, so this affects how people function.

People who change shifts every few days are going to have all kinds of problems related to memory and learning, Fishbein said. This kind of schedule especially affects what he called relational memories, which involve the ability to understand how one thing is related to another.

In addition to drowsiness and inability to concentrate, people working night shifts are more subject to chronic intestinal and heart diseases and have been shown to have a higher incidence of some forms of cancer. The World Health Organization has classified shift work as a probable carcinogen.

“We have 500 cable channels, we take work home with us on our Blackberrys and computers, both work and entertainment options are available 24 hours a day seven days a week and there is much more and brighter light exposure in our homes in evenings, which affects hormones involved in sleep, Czeisler said.

“And we are still trying to get up with the chickens because our work hours are starting earlier and earlier,” he said.

Today, controllers are at the center of the firestorm, with recent reports that several planes couldn’t contact airport towers for assistance in landing. Members of Congress are responding to a worried public, controllers have been suspended and the head of the government’s air traffic control system has resigned.

President Barack Obama told ABC News that controllers must stay alert and do their jobs.

One old solution back in the news is allowing night workers to nap.

“There should be sanctioned on-shift napping. That’s the way to handle night shift work,” said Gregory Belenky, a sleep expert at Washington State University in Spokane.

A NASA study suggested that pilots on long-distance flights would perform much better if given a chance to take a scheduled nap, as long the rest was planned and the both pilots didn’t sleep at the same time.

“But even though that’s been known for decades, it’s never been allowed because we prefer to pretend that these things are not happening,” instead of managing the problem, Czeisler said. “We have a bury-our-head-in-the-sand attitude.”

Controllers are often scheduled for a week of midnight shifts followed by a week of morning shifts and then a week on swing shifts. This pattern, sleep scientists say, interrupts the body’s natural sleep cycles.

Many of the Federal Aviation Administration’s 15,700 controllers work schedules that allow no realistic opportunity for rest. Their record for errors on the job has grown sharply over the past several years.

FAA rules prohibit sleeping on the job, even during breaks. Employees who violate them can be fired. But controllers told The Associated Press that napping at night where one controller works two jobs while the other sleeps, and then they swap, is an open secret within the agency.

Czeisler also is urging screening of truck drivers for sleep apnea, a breathing problem they can be prone to because many are obese. He estimates that as many as 250,000 people in the U.S. doze off while driving every day, mostly in the daytime.

Studies have shown that a sleep-deprived driver is as impaired as someone with enough alcohol in his blood to be considered a drunken driver.

Even a drunk has some reflexes. “If you fall asleep, your performance is much worse,” he said.

Since the Federal Motor Carrier Safety Administration came into existence in 2000, there have been considerable changes and requirements imposed on trucking, with Congress providing the agency with a long list of regulations to implement. Significantly, one issue—driver fatigue—is being tackled from three different angles:

In response to congressional mandates, there have been two instances of hours-of-service regulations issued since 2003 and a third regulation is under way, due for release in July.

The National Transportation Safety Board has issued a series of recommendations to FMCSA for changes to existing rules touching on driver fatigue while calling for new regulations. One example has been to screen truck drivers for obstructive sleep apnea (OSA) as part of an overall fatigue-management program. So pervasive is the OSA problem that the NTSB has issued similar warnings to the aviation, maritime and rail industries for their employees.

Most significantly, FMCSA’s new Compliance, Safety, Accountability program, or CSA, attempts to expand the scope of regulatory oversight of motor carriers and drivers. The program will add tools to the conscientious safety manager’s toolbox and identify trends in driver behavior—including fatigue—before they cause crashes.

And yet, while drivers and motor carriers await the new hours-of-service rule, momentum for broader fatigue management among the most safety-conscious motor carriers is building without government mandates.

Much debate surrounds the hours-of-service rule and its effect on driver health, but reducing the hours a driver can work or drive will not remedy the health problems caused by obstructive sleep apnea. In fact, the effort expended on HOS changes is likely to produce fewer safety benefits than the industry could capture simply by aggressively addressing the health of today’s commercial drivers through targeted treatment of OSA.

OSA deprives a driver of deep sleep because the airway in the back of his throat is obstructed for 10 seconds or more. Reduced oxygen wakes the sleeper just enough to start breathing again but not enough to remember the action. And this can happen more than 50 times per hour. The result is a driver who is almost as fatigued in the morning as when he retired for the night — and doesn’t know why.

Estimates vary, but based on one 2006 study used by the FMCSA Medical Review Board, which provides the agency with recommendations regarding medical requirements for commercial vehicle drivers, suggests that between 24% and 41.9% of all commercial drivers could qualify for OSA screening.

The MRB recommended in January 2008 that FMCSA make substantial changes to the current guidelines pertaining to OSA.

OSA testing and treatment options are varied. Traditional testing can require two or more overnight stays in a sleep clinic to test for OSA and determine if the patient will benefit from sleeping with a special mask that keeps the airway open with a continuous flow of air.

Truck drivers, however, need to be diagnosed and treated expeditiously because fleet owners require healthy and treated drivers available for daily duty. For these companies, ambulatory testing of drivers holds tremendous promise because it can be done while a driver sleeps at home, in a hotel or even in his cab’s sleeper berth.

Savvy industry executives realize that drivers are essential to their business and treating OSA where needed is an investment in those drivers, their families and the company’s viability. Data clearly show that with effective management of OSA, individuals experience improved quality of life and fewer catastrophic illnesses and diseases.

Motor carriers have a unique opportunity to address potential safety liabilities within their companies by establishing OSA programs. When this has been accomplished, they will be rewarded with healthier, happier and more productive employees with fewer health claims as well as reduced crash numbers and workplace injuries.

After a successful pilot program, Gordon Trucking has chosen Sleep HealthCenters to provide a nationwide comprehensive sleep apnea screening and treatment program. The program is designed to enhance roadway safety by improving the health of commercial drivers through education, diagnosis and treatment of sleep apnea.

According to the National Sleep Foundation (NSF), it is estimated that insomnia, obstructive sleep apnea (OSA), narcolepsy, excessive daytime sleepiness and restless legs syndrome plague an estimated 40 million Americans. The Federal Motor Carrier Safety Administration (FMCSA) has publicly announced a focus on fatigue in commercial drivers, specifically addressing the potential impact of sleep apnea. Regulations surrounding these issues are possible.

Gordon Trucking has a history of supporting the health and wellness of their drivers. Managing sleep apnea is another important step in Gordon’s efforts to improve driver fitness. The driver screening program is expected to begin before the end of the year.

“Gordon has a tradition of long-term safety efforts and we are committed to offering our drivers a sophisticated sleep apnea screening program.” said Scott Manthey, vice president of safety for Gordon Trucking. “We are confident that Sleep HealthCenters has the expertise to provide us with the most comprehensive screening program available to keep our drivers and roadways safe.”

“Healthy sleep is vital to employee wellness and safety, but for trucking companies, it can be difficult to implement a program for employees who live in different places, are constantly moving around the country, have different primary care physicians and maybe even different health insurance coverage,” says Dr. Lawrence Epstein, chief medical officer at Sleep HealthCenters, based in Brighton, Massachusetts.

Sleep HealthCenters works with a network of affiliated and highly qualified sleep medicine providers to serve drivers around the country, guaranteeing that employees will have minimal wait times for diagnosis, treatment and follow-up care.

“Our network of sleep specialists and respiratory therapists help the patient select an appropriate treatment and monitor their response to therapy.” says Sleep HealthCenters’ CEO Paul Valentine, “Our proprietary web-based system, called PAPCenter, allows us to monitor each patient’s device utilization even though they may see different therapists while they are on the road in different states. All therapists are licensed in the state in which they treat Gordon Trucking patients, and the clinical standards of care are standardized throughout the program to ensure the patient receives the highest level of reliable and predictable service.”

Sleep HealthCenters, based in Massachusetts, has a system of comprehensive sleep medicine centers and clinics. The company currently runs 26 facilities in Arizona, Connecticut, Massachusetts and Rhode Island and is affiliated with academic medical institutions such as Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, both in Boston.

Gordon Trucking was founded in 1946 in Pacific, Washington and is today one of the leading U.S. long haul carriers with over 1,500 drivers nationally. Gordon Trucking is privately owned and managed by the Gordon Family. Larry Gordon, president and CEO purchased Gordon Fast Freight from his father in 1984 and formed what is known today as GTI. For more information on GTI, please visit their website at www.gordontrucking.com

BRPT has been notified that the Board of Directors of the American Academy of Sleep Medicine (AASM) has decided to develop a certification exam for sleep technologists to be administered through the American Board of Sleep Medicine (ABSM). The ABSM has indicated that the exam will be developed over the next six to twelve months. […]